Eye Expert Witness Testimony for Orbital Fractures

Fractures involving the bones of the orbit are a common consequence of forceful eye injury.  An eye expert witness is often called on the causation and ramifications of orbital fractures.  The orbit, also known in lay terms as the “eye socket” is composed of several important bones. One of the most important bones is the maxillary bone which makes ip most of the floor of the orbit.  The maxillary bone is also the roof of the sinus that is located in the skull.  A fracture involving the maxillary bone is also known as an orbital floor fracture.  Expert witness testimony from a board-certified ophthalmologist may be used to explain the relevant anatomy of the orbit and the elements that have meaning in a particular case.

Damage to the floor of the orbit can result in double position, altered position of the eyeball, hemorrhage, and altered circulation to the eye.  Other significant problems caused by an orbital fracture includes damage to the muscles that control movement of the eye and damage to the nerve around the eye.

Extensive reports in the literature review the indications for surgery, timing for surgery, and length of post-operative care.  Some surgeons promptly repair orbital floor fractures based on their appearance on CT radiologic scans.  Many of these surgeons surmise that extensive fracture of the orbital floor can potentially lead to significant problems.  Other surgeons follow the course of injury for any signs of complications that would indicate a need for repair.  Signs of injury include vision-disabling double vision (diplopia) or asymmetry of the face.

A comprehensive history, clinical examination, and radiologic scans are key bits of information utilized by physicians in their evaluation of orbital fractures.  The hydraulic theory that explains fractures of the orbital floor is that pressure from an external force causes the eyeball to become displaced and fracture the weakest portion of the orbit.  The buckling theory is that direct trauma to the front rim of the orbit leads to buckling and fractures of the orbital floor.  In reality, the mechanism that causes fractures of the orbital floor are not exclusively due to one factor, but due due a combination of factors.

The symptoms of orbital floor fractures include pain in the orbit, backwards displacement of the position of the eye (enophthalmosis), loss of sensation of the cheek and teeth due to damage to the canal along the bottom of the orbital that contains a branch of the Trigeminal nerve for facial sensation, and double vision when looking upwards.  Trauma to the eye can also cause swelling of the soft tissue around the ye socket, drooping of the eyelid, and dilation of the pupil.

A careful eye examination may include vision testing, checking pupil reactions, and mobility of the eye in various positions of gaze.  Although displacement of the eye position may be determined by visual inspection alone, an instrument known as an exophthalmometer can be helpful for quantifying the amount of displacement.  A slit lamp is helpful for detecting a corneal abrasion, blood or inflammation in the eye, a dislocated lens, cataract, or damage to the retina including a retinal detachment.

The decision for orbital surgery is not taken lightly since it has the risk of potentially significant complications.  Eye experts point out that some of these potential ocular complications include loss of vision, infection, double vision, and malpositioning of orbital implants that are used to repair fractures of the orbit.

Individuals with orbital fractures which have entrapment of the trigeminal nerve may experience what is known is increased vagal tone that causes a slowing of the heart rate and heart block.  These patients often have nausea, vomiting, and dizziness.  This condition often warrants prompt surgical intervention because if may be fatal.  Eye expert witnesses and experts in plastic surgery point out that another reason for early intervention is when there is significant facial asymmetry from large fractures of the orbit.  For example, urgent repair may be indicated if the eyeball prolapses into the sinus cavity through a large fracture in the floor of the orbit.

An eye expert witness can be helpful in explaining the cause of a fracture involving the orbit and the possible adverse consequences of this situation.  Damage to the bones of the orbit can change the position of the eye within the eye socket leading to multiple deformities and symptoms of double vision.  Individuals who suffer an orbital fracture can also have internal damage to the eye that includes hemorrhage, bleeding, and retinal detachment.  A dreaded problem associated with trauma causing orbital fractures is that of a ruptured globe.  Many of the complications associated with orbital fractures requires prompt attention.

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